Telecare Soapbox: Predicting the telequake

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/09/earthquake.jpg” thumb_width=”175″ /]Predicting earthquakes is notoriously unreliable but TTA’s ex-Editor in Chief Steve Hards says that one is on its way for the telecare and telehealth industry.

Earthquakes are hard to predict because, depending on the local geology and where you are in relation to the future epicentre, they vary in speed, intensity and effect. However, there are four generally recognised stages:

a long period of between quakes when straining deep beneath the surface that goes unnoticed

a build up of intense pressure along the fault which may be noticed as slippage

the release of the pressure which causes the well-known effects of tremors, liquefaction and damage as the two sides of the fault realign

the new resting position of the land each side of the fault

O2 and Bosch realising that systems which do not use smartphone-based technology are now dead in the water and therefore exiting from the UK telecare market was not the quake; they are just signs of stage two slippage. We will see more strains and cracks appear over the next couple of years especially in the UK where almost all installed telecare systems are landline- and pendant-based. But it is not just a matter of technology, there is strain beneath the surface of the systems.

People close to telecare know better than anyone that the benefits of increased security, reassurance and independence are less real with current systems than their necessarily upbeat announcements lead the public and the commissioners of services to believe. Public perception and confidence is a fickle thing which can evaporate quickly. It will only take a few incidents such as the recent death of a telecare user in Scotland to cut the ground away. Revealed: system failure in fire death (Inverness Courier)

It may be stage two I am observing now but I believe I have seen what could trigger stage three of the telequake. The changed landscape that will result does not look good for current telecare suppliers.

So what will release the building strains and stresses and trigger the dramatic third stage of the telequake?

An NDA constrains me from being too specific but I can say that there is a wrist-worn/Android smartphone device which has been developed under the radar in the UK for the past few years which knocks the socks off any current telecare device. I have seen it working. It has all telecare scenarios covered and brings real intelligence to bear on any potentially dangerous situation for the user. Telehealth applications are close to completion. If it can be brought to market in the next couple of years we will see a huge upheaval and dramatic rearrangement of the landscape.

To bring the device to market the company developing it now needs a licensing deal with a large, well-resourced and highly ethical company. If any TTA readers are sitting in such a company wondering how to move quickly into this market email me and, if your company is acceptable to the developers, I will put you in touch. (Steve’s email)

You’ve heard the prediction. Where do you want to be when the telequake strikes?

Steve HardsFormer Editor in Chief, Telehealth & Telecare AwareDisclaimer: The company concerned paid travelling and overnight expenses for me to visit them but I have no financial interest in the success of the company.

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There are a myriad of new devices on the market, coming to market and still in development – technology generally is moving much more quickly than people can currently cope with. Let’s hope that lessons are being learned on stakeholder engagement, understanding who can genuinely benefit and how, interoperability, fit with lifestyle, flexible service configurations and personalisation, privacy and reliability, evidence expectations, business and service models.

Resistance to change and new ideas particularly using technology remains high in the health and care sector (UK and worldwide) for many understandable and well-documented reasons so any new product/service needs to look carefully at the cost-effectiveness of what is being offered and its scalability.

Interesting read, if it does what it says on the tin then either this or one or more of the other new-comers in the pipeline could be a real game-changer.

Over the last two or three years there’s been a couple of devices I’ve come across on the internet which have been new and look like a real advancement. I’ve mentioned them to people within companies, but although they say it looks good, I get the impression they won’t do anything about it. I guess all their resources (financial and technical) have been invested in the current landline based technology, and they therefore see this as too much of a change in direction. Personally, I feel that they should be looking to evolve into the mobile market, but Ostriches do love their sand!

Unfortunately, they have all spent a lot of time and effort telling their existing clients how the mobile network is unstable and too risky, compared to good old landline, so to suddenly put their whole operation into reverse will no doubt put a bit of strain on their credibility gearbox! But why can’t mobile and landline devices work in a complementary way to each other?

As a service provider, a device like the one Steve describes opens up whole new avenues, and I’d dearly love to see it put through its paces. Already we are seeing the “younger” older people turning their noses up at the traditional equipment. They are, as yet, not demanding something more 21st Century, but the questions are being asked more frequently, and surprise is being expressed more often that they aren’t monitored when out and about. The additional functions of mobile devices would have a great deal of appeal to a rapidly growing market.

Many of my colleagues locally, and probably farther afield, are less aware of the new products just around the corner, and are happy to plod on with what they are fed by “the traditional companies”. That attitude may act as a damper to change, but once the public become aware of what is available, demand will wake some up and create competition to those that insist on staying traditional.

I do agree with Steve’s comments about an earthquake coming, and unless the traditional Telecare companies prepare, they will be left behind and probably face extinction at worst, or a severe loss of position in the marketplace at best.

It’s no longer a matter of if, but when. Buckle up it could get bumpy!

I agree with Steve’s prediction of major changes ahead for the industry, but feel that the earthquake analogy isn’t perhaps correct. An earthquake has the effect of destroying just about everything thus forcing society to start again – and it’s a lot easier starting from scratch than trying to build on an existing sub-optimum infrastructure. So unless we have the misfortune of experiencing a catastrophic failure of a fundamental part of a telecare system that forces us to abandon complete services, I would suggest that we need to prepare to weather 2 or 3 major storms or hurricanes rather than something more devastating. We should be trying to make systems sufficiently robust to overcome such disaster, natural or otherwise, but it shouldn’t be a reason for abandoning services that have matured over decades and which are already providing valuable support to millions of people. The most important part of such services are the people (both receiving and delivering them) – technology is only a vehicle, at will continue to be so until the care is actually provided by machines. I know that this is possible, and personal care assistant machines are already being prototyped, but I suspect that we will allow the Japanese and South Koreans to test these for a few years before they become standard parts of care packages in Europe, North America and Australasia.

Perhaps it is the emergence of mobile systems that offers the most disruption to existing telecare services, especially if more people abandon fixed lines in favour of mobile options. True, the use of mobile overcomes some of the risks associated with landlines including those of next generation network issues (e.g. using an analogue device on a digital system) and the possibility that the user unplugs their telephone line from the socket, or fire burns through the wiring, but there are similar problems associated with mobile phones, including the user choosing to switch it off. It should also be appreciated that there are many common failure modes at a network level that could cause failure of a telecoms system. If a local earthquake (e.g. a JCB digger) goes through power or fibre optic cables then they could be serving mobile masts in the same way as they might be serving a BT telephone exchange. Good telecare services already have disaster recovery plans in place to deal with most possibilities.

I suggest that we don’t need to throw the baby out with the bath-water but should instead look at the weaknesses of current provision. Continue to perform risk assessments and deal, as an industry, with emerging problems. After the Potter’s Bar rail crash, the aviation industry took advantage of train delays to develop low cost airline alternatives, which led to Easyjet, Ryanair and others increasing their business by incredible amounts. But what happened when an Icelandic volcano through ash into the atmosphere? If we have to think about extreme events then we will have to consider the effect of sun-spots, electromagnetic storms, and asteroid collisions – but this wont necessarily affect the way that we plan and operate services.

So to return to Steve’s points, I don’t believe that the withdrawal of O2 Health was in any way associated with failures in existing service infrastructures. Their proposition was a step in the direction of personal mobile devices and was more to do with the here and now, retail options, public awareness and the preferences of people who are in the old, old group i.e. those over 85 years of age. Many are house-bound – which means that mobile options are irrelevant, and also means that they can’t get out to see and try the devices in a bricks and mortar shop. They might also struggle to see letters and numbers on a small screen, and to press small buttons. Surely, though recognising the dangers of generalising, they want to use familiar objects. This is why I am convinced that the most popular interfaces are likely to be the TV, and that includes the massive 40 plus inch contraption that dominates their living room as well as the smaller unit in their bedroom, and perhaps one integrated into their fridge or a cupboard on the kitchen wall. They might be happy to carry the on-off switch on their wrist – but I struggle to see them wanting to replace the watch that they had from their late spouse with something more intelligent and which doesn’t need to be wound everyday and taken off every night as they have done for the past 50 years.

Steve – the emerging telecare market will require an array of devices to suit particular needs. To say that one device “knocks the socks off any current telecare device” seems a bit blinkered. In my opinion, there is a already a huge market for devices which do not require the customer to wear anything or do anything in order for it to operate.

Is the earthquake analogy appropriate? Only time will tell. I didn’t intend it to be about destruction of services for users but about a dramatic re-shaping of the market.

It’s now a commonly held belief that ‘it’s not about the technology’ and attention has switched to the culture and context in which the technology is failing to embed. But – heretical thought – what if it IS about the technology? What if the resistance has arisen because the technology is not yet simple enough and intelligent enough for its adoption to become the obvious choice? I’m thinking about a parallel with the move from ‘ordinary’ mobile phones to smartphones. It was a shift from phones to small form computers that also make it easier to phone. That was all about the technology, surely?

Editor Donna: This is from a poster who wishes to be anonymous due to his position in the field.

It is my opinion that too much time and energy has been wasted in considering such negatives as ‘stakeholder engagement, understanding who can genuinely benefit and how, interoperability, fit with lifestyle, flexible service configurations and personalisation, privacy and reliability, evidence expectations, business and service models’ The only thing missing from this quote is to add the weight of the Technology Prevention Officers in the NHS who have done a sterling ‘thin red line’ job for so long. Then you can understand why, the way Telecare is delivered in the UK desperately needs the Telequake Steve predicts.

Telecare should mean CARING FOR THE USER, not the fat cats feeding their pension. If we designed the technology around the user, not around the list of jobsworths mentioned above, so that granny doesn’t have to be retrained to use a QWERTY keyboard or a Big button Home Hub, or the internet, or punch in numbers to upload data, or find her glasses to see who is calling or use a ridiculous keypad that ordinary people can hardly use, never mind the arthritic and visually challenged. Instead of trying to make the user fit the technology, why not make the technology fit the user? That’s a frightening thought for the entrenched providers, they might have to invest in a little R&D.

My GP’s inform me that iPhones are now ‘medically acceptable devices’ but they don’t care anyway because they saw the benefits of the technology and ignored the NHS on the premise that ‘If it is good for my patients I will use it’. When the right mobile technology does come along, the decision will thankfully be taken out of ‘the institutions’ hands by the users and the adoption barriers will fall. The users, their carers and the GPs, will breathe a big sigh of relief, the Government is already insisting the NHS adopts new technology and let’s face it, the 1990’s technology in the Telecare market is the softest and most visible target. There will be nowhere to hide from the Telequake.

The reality here in Sweden is that 90% of new carephones/social alarms are now GSM enabled. Last year circa 15 000 GSM devices were installed by local authorities to replace failing, analogue devices which were struggling to communicate via next generation digital networks. The Swedish Institute of Assistive Technology backed by a government mandate has been advising all municipalities that a digital solution is required and that the whole alarm chain needs to be replaced by a secure alternative.

However, as Kevin observed, the needs of today’s users are not generally met by portable smartphones. The average carephone user in Sweden is possibly 5 years older than a typical service user in the UK. Independent living initiatives are in place to ensure that people live as long as possible, with security and dignity, in their own home and that means support from simple, accessible technology.

The units currently deployed are GSM enabled devices looking largely like a modern, yet ‘traditional’ carephone with big buttons and easy to operate triggers with the option of adding associated telecare devices. It’s a familiar, simple device (that doesn’t need a daily charge) used by people who don’t need a social alarm outside their own home. The number of calls generated by these older and potentially higher dependency users is also significantly higher than in the UK. As an example CareTech’s Trygghetsjouren response business in Malmö receives close to 250,000 calls a month from 50,000 users.

Mark is correct that in the UK the technology suppliers have largely stuck with analogue, landline based devices but they will need to change. The Telcos are increasingly interested in what they see as a huge, demographics driven M2M opportunity. The costs of a monthly agreement inclusive of data and speech, potentially on a secure roaming SIM basis is dropping and is becoming less than the cost of a traditional PSTN analogue line. If the trend in Sweden is replicated the GSM carephones will become cheaper and will eventually replace a fitted base in the UK of close to 900,000 devices.

Yes Steve, there will certainly be a market for smart phone, android based devices in the future appealing to a younger, tech savvy, more mobile user. However, these are not the people who will very soon need a replacement social alarm that works on GSM.

Maybe not a Telequake yet but the tremors created by old, analogue technology are being felt in a digital exchange somewhere in your vicinity..

I have seen the product Steve started the topic on; and like him I am unable to say too much.
Due to not being able to say too much it makes it difficult to put some points across.
What I can clearly state is that there is nothing like this, that I am aware of, anywhere. Also that the arguments above are based on preconceived ideas of what technology there is available and the NDA prevents me from putting across an alternative to some of those opinions.

Ageism is alive and strong mostly within the the very arenas that people look to for assistance. Some of the strongest opponents of technologies and affiliated services have been the very ones I would go to if I were my Grandad’s age. Are they thinking of what is best for me? Are they taking into account responsible roles I have held and the amount of change I have seen and gone though in my lifetime – some of it enforced but lots by choice?

We need to be very wary when we work off straw polls, questionnaires, other’s beliefs. You can get whatever answer you want if you ask the right question but sit down with someone and work through their issues and come up with solutions that suit them will give you a better insight indeed. If my Gran could programme her freeview box after the switchover then she could conquer any care technology the world threw at her easily; so long as she knew why she was doing what she was doing and how it helped her. The tools to do it didn’t make any difference – so long as there were not any tiny fiddly bits.

Talking about landline or GSM or IP or a mixture of all three or one or some is almost yesterday’s thoughts. Talk about how people interact with technology and what people want out of technology and who wants what out of a system from all the relevant shareholders is a good place to start.

I hate the term but when I saw the product I said it was ‘a game changer’. I will stick with Steve in his earthquake analogy as I am sure you all would if you had seen it. The only difference may be the number on the Richter scale you see it as.

Maybe I’m getting too long in the tooth for all this NDA nonsense – but I reckon that anyone who forces well-educated and sincere industry observers to sign confidentiality clauses is scared that their product isn’t as revolutionary and game-changing as they think!
We all know that the future is likely to be mobile (unless you need lots of bandwidth for really clever high definition video, hologram or virtual presence stuff). That opens up lots of options for worn devices, implanted devices, smart tattoos and other sensors worn in places that are far from ideal from an accuracy point of view (and that includes the wrist!), and they will feed Big Data analytics in the cloud that will try to predict things (which we may not want to know). They will be able to interact with us on our Google specs, watches, tablets and smart TVs – and wont be able to understand why we switch the damned things off!
So what can be truly mindblowing to an old cynic like me and to my 92 year old diabetic father who would throw out technology as soon as a screen freezes, the wrong button is pressed, a recorded message is played to him, or someone suggests to him that he should get more exercise, change his diet, or turn up the heating?
Answers on a postcard please – unless your NDA gets in the way.

You are right Kevin in that the future is somehow mobile and as you say, that is obvious. There will never be a perfect solution – we work with a button and box for a millionish people with 80+% choosing not to wear the button.

I don’t think anyone has said that this is the perfect solution for everyone – after all that is the exact sales pitch we heard for years from providers. One size does not fit all which is why the days of mass purchasing are coming to an end and a more personalised approach is required that does not involve unnecessary intermediaries hampering the process/journey.

There will also always be people that no matter what we think may help, or assist or enable or another newer term, them they will be resistant to any change.

We can keep things simple whilst still embracing new technologies which is something you (Kevin) have been at the forefront of explaining to people for years. You are far from being an old cynic too.

I think as far as the NDA goes it could just be a simple case of once bitten, twice shy.

I enjoyed Peter’s comments immensely but would like to ask what percentage of the 250,000 calls were false alarms? Could the majority of false alarms have been eliminated at source? Why not, it would save a lot of ‘infrastructure costs’? Why do you say they don’t need a social alarm outside their home? Is that because your systems won’t allow them to go outside their homes? If people need monitoring, and millions do, why not monitor them properly, 24 hours a day anywhere? Why make them stay at home (in the waiting room) next to a big button phone or Home Hub? Is it simply because if they leave the safety of a home hub, (heaven forbid) you may have to think of a way of locating them and of informing the carer where they are if something happens? Did you know that fresh air and gentle walks deliver massive health benefits, have a chat with any doctor you might be surprised that they don’t share your view of people being ‘confined to barracks’ because of inadequate technology.

Your comments that you agree that there will indeed be a market for younger, tech savvy users is encouraging; unfortunately the younger, tech savvy users is not our target market. The product wasn’t designed for the tech savvy or to be hung on the back door next to their pendant; it was designed specifically to deliver care discreetly and to support the users wherever they are without a training course or hefty installation charges. The days of trying to force the end user to fit the existing offerings is totally wrong, gone and definitely ‘yesterday’s thoughts’.

Kevin, have a look at a patent application; you will understand why NDA’s are a must. We have no concerns about the deliverables of our products, or it being game changing, because well-educated and sincere people in the know have seen them all in action first hand and approved. The industry has been littered with failures, start-ups, crowd funding wanabees, website nonsense, revolutionary home hubs, and radical new big button phones. Big players have thrown millions of dollars at the industry and have stumbled and failed. Why? Because the solutions were designed simply to make money. No consideration was given to the end users’ problems, whether physical, social, mental, financial, or all of them.

I believe after 5 years of development, that taking advice from well-educated independent and sincere people in the know before we launch is a very very good idea, as is working with GPs and clocking 5,000 hours of user trials to eliminate any wrinkles.

As an aside, older people have no problem with (some) technology. They have all embraced TVs and radios and would hardly throw them out of the window if the screen froze = they would contact a repair service instantly because the technology has become a necessary part of their lives. I have heard that some even have mobile phones as well, but that’s probably just a rumour!

I would also like to ask what the well-heeled ‘establishment’ are doing about eliminating abuse in care homes. Someone needs to come up with a solution to help these people, are they developing solutions, or is that someone else’s problem as well? We see it as an opportunity and a challenge we are happy to accept.

I feel confident in predicting that during 2014 our telecare products will be successfully delivered in volume by a telco yet to be named. I can also predict that a state of the art complementary telehealth product will follow in 2015, along with a care home monitoring system which, by the way, doesn’t use a mobile phone platform.

Our definitions

Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:

• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.

• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.

Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.